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Embracing new technology and new ways of working in South Tyneside and Sunderland
South Tyneside and Sunderland NHS Foundation Trust (STSFT) provides a wide range of community and acute hospital services to a core population of around 430,000 people living in and around the borough of South Tyneside and the City of Sunderland, as well as parts of County Durham.
In addition, the trust is also one of three tertiary centres in the North East providing a range of specialist services including renal medicine, urology and ophthalmology, serving a wider population of almost one million people.
With an annual income of over £550m, STSFT operates from two main hospital sites, Sunderland Royal Hospital and South Tyneside District Hospital, as well as Sunderland Eye Infirmary, and employs over 8,000 highly committed staff.
Sunderland Royal Hospital recently became the first hospital in the UK to fulfil the requirements of the Global Digital Exemplar (GDE) programme, making STSFT the first trust in the North East (and second across England) to be awarded HIMSS Level 7 status - an international standard for digital adoption within a hospital setting.
Having already been appointed as a GDE site in 2017, Sunderland Royal Hospital nominated, and was successful, in securing South Tyneside District Hospital as its ‘Fast Follower’. Following the merger which created STSFT in April 2019, it was crucial to create a single acute electronic patient record (EPR) solution across all trust facilities.
Using Sunderland Royal Hospital’s ‘GDE blueprint’, South Tyneside District Hospital successfully implemented a full EPR (from scratch) in only 14 months by April 2020 at reduced cost and risk.
What were the aims?
STSFT’s vision is “to deliver nationally recognised, high quality, cost effective, sustainable healthcare for the people we serve, with staff who are proud to recommend our services”. The trust’s IT EPR strategy is core to achieving this, with a clear ambition to be ‘paper-free at the point of care’.
The interoperability agenda, whilst posing the greatest challenge, holds enormous potential to transform the interactions between health and social care agencies. The trust is actively engaged in the development of the Great North Care Record to realise a regional interoperability framework throughout the North East and north Cumbria.
STSFT’s ambition for patients are:
- a more efficient service, with improved scheduling capabilities and communication
- having to only convey information once - for example demographics, history, allergies
- improved continuity of care across the wider health system
- improved treatment plans, better outcomes and less time in hospital
- online access to their EPR and ability to positively influence their own care
- different ways of receiving treatment using technology - without attending hospital
STSFT’s ambition for staff are:
- the ability to access and record all patient data on a real-time, 24/7 basis, via the EPR
- up-to-date patient information at the point of care resulting in more timely and improved decision-making, reduced clinical risk, improved outcomes, reduced mortality and system-wide efficiencies for STSFT and partners
- clinical decision support functionality embedded within the EPR to support diagnostic test ordering and treatment plans, instigate interventions, transmit alerts and ensure patients get the correct treatment at the correct time (reducing clinical incidents and their impact)
- access to non-STSFT digital health and social care records and access to up-to-date patient information quickly and easily
- improved efficiency and more time to deliver direct patient care
- improved staff morale and organisational reputation as ‘digitally mature’
- improved clinical data analytics, resulting in improved strategic planning and more innovative treatments
What were the solutions and impact?
Both the Sunderland GDE and South Tyneside GDE 'Fast Follower' programmes have delivered against all objectives to time and budget, endorsed by NHS Digital and NHSX. This includes HIMSS Level 7 Electronic Medical Record Adoption Model (EMRAM) accreditation for Sunderland Royal Hospital (now the only hospital in the North of England to achieve such status) and the first to achieve GDE objectives. The GDE programme and initiatives were deployed trust-wide.
At the Sunderland Royal Hospital site, the integrated EPR means all clinical teams have access to live, up-to-date patient information at the touch of a button. Whether a patient is in the Emergency Department (ED), inpatient ward, diagnostic area, therapy or outpatient appointment, the EPR has greatly improved ability to effectively and safely manage patient care. Staff can update records in real-time, prescribe medication and record vital signs from the bedside using scanning technology and digital patient wristbands.
Sunderland Royal Hospital became the first in the country to adopt electronic paper free working within the ED, provoking a cultural change across its extended workforce to embrace new technology and new ways of working. The tracking of patients has been pivotal to allow the successful transition to a new department footprint. Nursing and medical documentation including patient pathways has provided clinicians with access to decision support and leaner workflows reducing unwarranted variation in practice.
At the same time as achieving this in Sunderland, STSFT also successfully implemented the same EPR system, from scratch, in what was historically a digitally less mature site at South Tyneside District Hospital. There is now a highly effective single acute EPR across the newly merged organisation which has resulted in:
- much improved efficiency and staff experience
- all administrative and clinical data being available (subject to access privileges) to any staff at any trust location 24/7
- improved communication with patients
- all trust diagnostic reports and clinical correspondence are transmitted to primary care electronically
- bedside monitors are directly interfaced to the EPR, informing decision support and decision making
- closed loop medication administration (including blood products) is fully deployed, with significant safety benefits
- enhanced clinical decision making through the EPR which is influencing diagnostic test ordering, treatment plans, instigating interventions and transmitting alerts as necessary
- electronic rule-based treatment plans are reducing clinical risk, length of hospital stay and positively impacting on mortality and patient outcomes
- STSFT securely sharing electronic information with health and care partners via the Great North Care Record (GNCR), meaning vital patient information is available to other healthcare settings across the region
- appropriate and secure access to information pertaining to patients’ treatment and care in other organisations via the GNCR
- significant time savings across clinical and administrative staff with reduced expenditure on medical records; for clinical staff, this is not cash releasing, however, time goes back into direct patient care (with associated benefits)
- significant reductions in stationery spend
- reduced incidents and complaints
The successful spread to South Tyneside within such a short time frame is evidence of the proven reliability and effectiveness of the trust’s IT and EPR strategy which was highlighted as outstanding practice by the Care Quality Commission (CQC) in January 2020:
The Trust had become a Global Digital Exemplar (GDE) site; a nationally recognised NHS provider delivering improvements in the quality of care, through the use of digital technologies and information. GDE sites share learning and experiences with other Trusts to enable them to quickly and effectively implement similar technologies.
In terms of interoperability, the trust is integrated with the GNCR Health Information Exchange, meaning information gathered at the point of care is available to other healthcare settings across North East and North Cumbria.
The trust continues to work with University of Sunderland, an academic partner, exploring big data with the Trust Research and Innovation department. Big data looks at large data sets that can be analysed computationally to reveal patterns, trends and associations. The trust is looking to collect needs from across the organisation where further work and collaboration with University of Sunderland can support improved patient care.
As a result of the widespread use of the EPR throughout the trust, and the expedited rollout of a trust-wide EPR at a relatively digitally immature site, there have been a number of requests for the trust to share experience. This includes with other NHS trusts and healthcare providers (nationally and internationally), some of whom are looking to procure the same EPR in use at STSFT, and many others who have expressed an interest in learning about the functionality in use, the benefits which have been realised, and particularly how the trust has governed and delivered the programme.
STSFT is continuing at pace with its Fast Follower programme at South Tyneside District Hospital and ahead of schedule against key milestones.
The trust will continue to share its knowledge and experience around the GDE programme and wider initiatives with other interested parties through conference calls, video conferences, on site visits and more.
“Make no mistake this is a major milestone in our digital journey for the Trust and the result of many years’ hard work and commitment at all levels.”
Ken Bremner, Chief Executive
“There is no doubt that our Meditech solution has greatly enhanced patient safety, outcomes and the quality of patient care, as well as improving organisation efficiency.”
Andy Hart, Director of Information Management & Technology
“Technology is embedded in everything we do, in all clinical processes and our nursing workflows to an extent where we have successfully eliminated our reliance on historic paper-based systems at Sunderland Royal Hospital.”
Kevin Joisce, CCIO
“Sunderland Royal Hospital has joined an elite of organisations around the world to achieve the internationally recognised HIMMS Level 7 standard. There is a clear commitment here to use technology to prove patient safety and the overall quality of clinical care.”
John Rayner, HIMSS assessor
“The result linked to the electronic clinical record helps ‘make sense’ of the result in the correct clinical context and see if the result has been actioned already or not.
We can check these results anywhere in the Trust.”
Dr Darren Bresnan, Consultant in Paediatrics
“We have a traceable pathway of results and acknowledgements. We’re able to do notices at peripheral clinics, not attached to our offices as before. We have a much quicker way of getting a reply from a colleague about a mutual patient.”
Dr Catherine Morley, Consultant in Rheumatology
“The ‘Notices’ function allows me to see a result, immediately access a patient’s inpatient medical records or outpatient letter and make a decision based on my previous management plan. I think that it offers a safer and more efficient approach compared to the previous paper system.”
Dr Catherine Barnes, Consultant in Geriatric Medicine
“Results are available in real time and can be acted on quickly. There is also a good audit trail of actions taken and therefore it’s very useful in case any queries arise.”
Dr Yogesh Raja, Consultant in Cardiology
“Allows swift access both onsite and remotely (including from home) to results - and increasingly correspondence - with other aspects of a patient's electronic record immediately to hand.”
Mr Chris Hartley, Consultant in Ear, Nose and Throat
“Technology is embedded in everything we do, in all clinical processes and our nursing workflows to an extent where we have successfully eliminated our reliance on historic paper-based systems. Our Board has long championed the use of technology with a clear and ongoing commitment to improve patient safety and overall quality of clinical care through the effective use of digital solutions.”
Dr Kevin Joisce, Consultant in Emergency Medicine and Chief Clinical Information Officer